Provider Demographics
NPI:1265472823
Name:HOGAN, THOMAS J JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HOGAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6602 WATERS AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2778
Mailing Address - Country:US
Mailing Address - Phone:912-350-6000
Mailing Address - Fax:912-350-6001
Practice Address - Street 1:4425 PAULSEN ST
Practice Address - Street 2:BLDG. A 1ST FLOOR
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3662
Practice Address - Country:US
Practice Address - Phone:912-350-6000
Practice Address - Fax:912-350-6001
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040099207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349783OtherWELLCARE
GA619196OtherWELLCARE
GA000680325CMedicaid
GA000680325DMedicaid
SCG40099Medicaid
GA110214365OtherRR MEDICARE
GA000680325EMedicaid
GA10065723OtherAMERIGROUP
GA110214365OtherRR MEDICARE
F96434Medicare UPIN